Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report Modified 17391 8406 0 Form and Instruction HAIC.400.1 Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report
2019 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Removed 0 0 0 Form and Instruction ABC.100.3 2019 ABC H. Influenzae Neonatal Sepsis Expanded Surveillance Form
ABCs Invasive Pneumococcal Disease in Children and Adults Modified 1270 212 0 Form and Instruction ABC 100.2 ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN (aged ≥2 months to <5 years) AND ADULTS (aged ≥65 years)
ABCs Severe GAS Infection: Supplemental Form Removed 0 0 0 Form and Instruction ABC.100.4 ABCs Severe GAS Infection: Supplemental Form
Active Bacterial Core Surveillance (ABCs) Case Report Modified 9840 3280 0 Form and Instruction ABC.100.1 Active Bacterial Core Surveillance (ABCs) Case Report
Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Modified 370 123 0 Form and Instruction ABC 100.5 ACTIVE BACTERIAL CORE SURVEILLANCE (ABCs) NEONATAL INFECTION EXPANDED TRACKING FORM
Annual Survey of Laboratory Testing Practices for C. difficile Infection Modified 160 45 0 Form and Instruction HAIC.400.8 Annual Survey of Laboratory Testing Practices for C. difficile Infection
CANDIDEMIA CASE REPORT FORM Modified 1700 1133 0 Form and Instruction HAIC.400.11 CANDIDEMIA CASE REPORT FORM
CDC's Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey Modified 110 17 0 Form and Instruction HAIC.400.5 CDC’s Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey
CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT Modified 16500 10450 0 Form and Instruction HAIC.400.7 CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT
Community-Associated CP-CRE Interview Modified 100 50 0 Form and Instruction HAIC.400.2 Community-Associated CP-CRE Interview
Data Elements Transferred to CDC for the HAIC Death Ascertainment Project Modified 80 1920 0 Form and Instruction HAIC.400.13 Data Elements Transferred to CDC for the HAIC Death Ascertainment Project
Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey Modified 450 38 0 Form and Instruction HAIC.400.10 Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey
FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW (English/Spanish) Modified 208 34 0 Form and Instruction FSN.300.2 FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW
FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM Modified 1638 136 0 Form and Instruction FSN.300.3 FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM
FluSurv-NET Laboratory Survey Modified 240 40 0 Form FSN.300.4 FluSurv-NET Laboratory Survey
FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Modified 8640 3600 0 Form and Instruction FSN.300.1 Influenza Hospitalizatin Surveillance Network (FluSurv-NET) Case Report Form
FoodNET Lab Survey Variable List Modified 700 117 0 Form FN.200.10 FoodNET Lab Survey Variable List
FoodNet Hemolytic Uremic Syndrome (HUS) Modified 100 100 0 Form and Instruction FN.200.9 FoodNet CDC's FoodNet Hemolytic Uremic Syndrome (HUS) Surveillance Case Report Form
FoodNet Variable List_ (CYCLOSPORA) Modified 420 70 0 Form and Instruction FN.200.2 FoodNet Variable List_ (CYCLOSPORA)
FoodNet Variable List_ (LISTERIA MONOCTOGENES) Modified 160 53 0 Form and Instruction FN.200.3 FoodNet Variable List,_ (LISTERIA MONOCYTOGENES)
FoodNet Variable List_ (SALMONELLA) Modified 8550 2993 0 Form and Instruction FN.200.4 FoodNet Variable List_ (SALMONELLA)
FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI) Modified 2900 967 0 Form and Instruction FN.200.5 FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI)
FoodNet Variable List_ (SHIGELLA) Modified 2340 390 0 Form and Instruction FN.200.6 FoodNet Variable List_ (SHIGELLA)
FoodNet Variable List_ (VIBRIO) Modified 460 77 0 Form and Instruction FN.200.7 FoodNet Variable List_ (VIBRIO)
FoodNet Variable List_ (YERSINIA) Modified 550 92 0 Form and Instruction FN.200.8 FoodNet Variable List_ (YERSINIA)
FoodNet Variable List_(CAMPYLOBACTER) Modified 5500 1925 0 Form and Instruction FN.200.1 FoodNet Variable List_ (CAMPYLOBACTER)
HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey Modified 10 2 0 Form and Instruction HAIC.400.6 HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey
HAIC MuGSI KPC and NDM Treatment Collection Form New 600 600 0 Form and Instruction HAIC.400.14 HAIC MuGSI KPC and NDM treatment collection form
HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Modified 11 4 0 Form and Instruction HAIC.400.3 HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey
HAIC-Surveillance Officer's Survey Modified 10 3 0 Form and Instruction HAIC.400.9 HAIC Surveillance Officer’s Survey
HAIC_LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE Modified 200 47 0 Form and Instruction HAIC.400.12 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE
Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report Modified 7880 3809 0 Form and Instruction HAIC.400.4 Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report
Total burden requested under this ICR: 89088 40733 0  
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